Claims Recovery Examiner

This is a fully remote position, open to applicants in California.

📋 Description

• Adhere to all Company and Department Policies and Procedures.

• Provide assistance in claims audit activities as necessary.

• Examine incoming recovery checks, finalize paid recoveries, and follow up with providers regarding outstanding recoveries.

• Support the Finance team with matching bank transactions and conducting bank reconciliations.

• Process and post daily refund checks.

• Compile weekly and monthly reports for management concerning refund requests and refunds received.

• Generate monthly reconciled reports of refund checks with Accounts Receivables for management and IPA analysts.

• Assess refund requests for accuracy in amount and reason.

• Extract and report claims data for tracking purposes.

• Prepare and send refund request letters to providers.

• Update claim notes and documentation with information on refund requests and received refunds.

• Review, report, and resend letters of overpayment dispatched 30 days or more prior.

• Investigate and follow up on claims issues related to overpayments.

• Verify pending claims for recoupment by offset with providers.

• Recover funds owed by providers on claims through offset.

• Investigate and follow up on provider inquiries.

• Coordinate daily with claims, finance, IT, provider network, eligibility, and other departments.

• Facilitate calls as necessary to verify or research claims refund information.

• Resolve claims issues stemming from processing errors and suggest improvements to prevent future errors.

• Assist claims team members with additional duties upon request.

• Provide support to other departments as required.

• Perform all other tasks as assigned.

⛳️ Requirements

• A minimum of five years’ experience in processing Commercial, Medi-Cal, and/or Medicare or other government agency claims.

• Experience with service/diagnosis coding.

• Understanding of claims rules and regulation turnaround times by line of business.

• Ez-Cap experience is preferred.

• Proficient in all Federal and state requirements regarding claim processing.

• Knowledgeable in medical terminology and coding.

• Proficient in using Outlook, Microsoft Teams, Zoom, Microsoft Office (including Word and Excel), and Adobe.

• Detail-oriented and highly organized.

• Strong ability to multitask, manage projects, and work in a fast-paced environment.

• Excellent problem-solving skills.

• Capable of self-management with strong time management abilities.

• Ability to function in an extremely confidential environment.

• Strong written and verbal communication skills.

🏝️ Benefits

• Fully remote work environment.

• Flexible work environment and schedules.

• 100% employer-paid medical coverage.

• 100% employer-paid vision coverage.

• 100% employer-paid dental coverage.

• 100% employer-paid life coverage.

• Paid holidays.

• Paid sick time.

• Paid vacation time.

• 401(k) plan.

• Additional employee-paid coverage options.